Cancer Control from the Community Oncology Perspective Lee Schwartzberg MD, FACP Director, West Cancer Center Chief, Division of Hematology/Oncology University of Tennessee Health Science Center
IOM Report 2013: Delivering High Quality Cancer Care
Themes Changes from 2008-2018 1. Cancer Care delivery changes 2. Practice Transformation 3. Rise of Precision Oncology and Complexity of Cancer Care
Current Status of Community Oncology Over 8,000 practicing community-based oncologists Over 30,000 practicing affiliated clinical staff Community Oncology treats >80% of adult oncology patients Community Oncology enrolls >60% of patients on NCI sponsored clinical trials
Change in Community Oncology over the past decade 1,654 clinics and/or practices closed, acquired by hospitals, merged, report financial struggles from 2008-2018 www.communityoncology.org
Consolidation in Community Oncology 11.3% increase in closings, 8% increase in consolidations since 2016 report www.communityoncology.org
Healthcare is consolidating
Practice Transformation Reimbursement Mechanisms: From Fee for Service to Value-Based Reimbursement APMs, MIPS Demonstration Projects : OCM Patient-Centered Care Extended and Weekend Hours Shared Decision Making Routine Collection of Patient-Reported Outcomes Clinical Pathways Evidence-Based treatment plans Algorithmic Approach to care trajectory Addressing Disparities
A Coordinated Cancer Care Team Nurses Physicians Providing Oncology Care Clinicians Providing Psychosocial Support and Spiritual Workers Navigators Patient Team Interaction Patients Palliative Care Clinicians (including hospice / end-of-life care) Pharmacists Advanced Practitioners Rehabilitation Clinicians IOM Report 2013: Delivering High Quality Cancer Care
Numbers of Oncology APs across the U.S. Total estimated to be 11,000 APs in oncology ASCO estimates about 3000 APs in oncology Oncology Nursing Society estimates: 2601 Nurse Practitioners in oncology 1173 Clinical Nurse Specialists in oncology HOPA estimates 2400 pharmacists in oncology APAO estimates 2000 PAs in oncology Kurtin SE, Peterson M, Goforth P, et al. White Paper: The Advanced Practitioner and Collaborative Practice in Oncology. J Adv Pract Oncol. 2015;6:515-527. American Society of Clinical Oncologists (ASCO). The State of Cancer Care in America: 2015. http://www.asco.org/sites/www.asco.org/files/2015ascostateofcancercare.pdf. National Commission on Certification of Physician Assistants. 2014 Statistical Profile of Recently Certified Physician Assistants. https://www.nccpa.net/uploads/docs/recentlycertifiedreport2014.pdf. Vogel W, ASCO 2017
What do community cancer centers need to provide today? Interdisciplinary Care Adapted from Nardi E, et al JNCCN 2016
Cancer Disparity a huge challenge www.nci.org
Advances in biology have driven enormous complexity and subtyping of cancer
FDA Oncology Approvals 2017 16 New Molecular Entities 13 Approvals in 11 weeks!
Framework for Precision Oncology Aggressive/ metastatic tumors Distinctive characteristic s Enterprisewide Cutting edge and emerging technologies Integrative heuristic algorithms Focused experimental validation? Evaluation committee Framework for decision making Hypothesis driven phase I trials Mechanismbased clinical studies Registry studies Pharmacodyn amic analyses Molecular mechanisms/ correlates Integration with preclinical studies Inform novel therapeutic trials or therapeutic combinations Garraway L, JCO, May2 0, 2013.
Summary: The last decade of community oncology Good quality cancer care is available in virtually every community in the US Consolidation of services is proceeding rapidly Cancer care delivery is markedly more complex than before Advances in biology and new therapeutic agents have made community oncology practice more challenging Oncology has never been more exciting and fulfilling-as more patients live longer and better quality lives, even with advanced disease